经椎间孔TESSYS技术治疗腰椎固定融合术后邻近节段退行性改变致腰腿痛效果观察
|
摘要
目的探讨腰椎固定融合术后邻近节段退行性改变致腰腿痛患者应用经椎间孔脊柱内镜系统(transforaminal endoscopic spine system,TESSYS)技术治疗的临床疗效。方法腰椎固定融合术后邻近节段退行性改变致腰腿痛患者50例,均行TESSYS术,分别于术前,术后3d及1、3、6个月行视觉模拟(visual analogue scale,VAS)评分评估疼痛程度,行日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估腰椎功能,应用Oswestry功能障碍指数(Oswestry disability index,ODI)评价肢体功能,记录术中及术后并发症发生情况。结果术后3d及1、3、6个月,腰痛VAS评分[(4.12±1.58)、(2.16±1.04)、(2.67±1.26)、(2.83±1.07)分]、腿痛VAS评分[(3.19±1.08)、(2.03±1.23)、(2.33±1.87)、(2.65±1.28)分]、ODI指数[(11.60±4.70)%、(9.80±3.60)%、(6.30±2.10)%、(3.90±1.70)%]均低于术前[(7.86±1.42)分、(5.62±1.06)分、(32.50±9.90)%],JOA评分[(24.89±3.46)、(27.58±3.36)、(25.13±3.24)、(26.43±3.62)分]均高于术前[(10.63±4.17)分](P<0.05);术中和术后未发生肢体麻木、肌张力减退、椎管内出血、脑脊液漏等并发症。结论腰椎固定融合术后邻近节段退行性改变致腰腿痛患者应用TESSYS技术治疗效果满意。
Objective To investigate the clinical effect of transforaminal endoscopic spine system(TESSYS)technique on lumbocrural pain induced by adjacent segment degeneration after lumbar interbody fusion.Methods TESSYS technique was performed in 50 patients with lumbocrural pain induced by adjacent segment degeneration after lumbar interbody fusion.The visual analogue scale(VAS)was used to assess the pain level before operation,on the postopretaive 3 day,and in 1,3 and 6 months after operation.The lumbar function was assessed by Japanese Orthopedics Association(JOA)score,and the limb function was evaluated by Oswestry disability index.The intraoperative and postoperative complications were observed.Results The VAS scores of lumbar pain were 4.12±1.58,2.16±1.04,2.67±1.26 and2.83±1.07,the VAS scores of leg pain were 3.19±1.08,2.03±1.23,2.33±1.87 and 2.65±1.28,and Oswestry disability indexes were(11.60±4.70)%,(9.80±3.60)%,(6.30±2.10)%and(3.90±1.70)% on the postoperative 3 day,and in 1,3 and 6 months after operation,significantly lower than those before operation(7.86±1.42,5.62±1.06,(32.5±9.9)%)(P<0.05).The JOA score was significantly higher on the postoperative 3 day(24.89±3.46),and in1,3 and 6 months after operation(27.58±3.36,25.13±3.24,26.43±3.62)than that before operation(10.63±4.17)(P<0.05).No obvious complications occurred during or after the operation as limb numbness,atonia,hematomyelia and cerebrospinal fluid leakage.Conclusion TESSYS technique is effective for lumbar pain induced by adjacent segment degeneration after lumbar interbody fusion.
Objective To investigate the clinical effect of transforaminal endoscopic spine system(TESSYS)technique on lumbocrural pain induced by adjacent segment degeneration after lumbar interbody fusion.Methods TESSYS technique was performed in 50 patients with lumbocrural pain induced by adjacent segment degeneration after lumbar interbody fusion.The visual analogue scale(VAS)was used to assess the pain level before operation,on the postopretaive 3 day,and in 1,3 and 6 months after operation.The lumbar function was assessed by Japanese Orthopedics Association(JOA)score,and the limb function was evaluated by Oswestry disability index.The intraoperative and postoperative complications were observed.Results The VAS scores of lumbar pain were 4.12±1.58,2.16±1.04,2.67±1.26 and2.83±1.07,the VAS scores of leg pain were 3.19±1.08,2.03±1.23,2.33±1.87 and 2.65±1.28,and Oswestry disability indexes were(11.60±4.70)%,(9.80±3.60)%,(6.30±2.10)%and(3.90±1.70)% on the postoperative 3 day,and in 1,3 and 6 months after operation,significantly lower than those before operation(7.86±1.42,5.62±1.06,(32.5±9.9)%)(P<0.05).The JOA score was significantly higher on the postoperative 3 day(24.89±3.46),and in1,3 and 6 months after operation(27.58±3.36,25.13±3.24,26.43±3.62)than that before operation(10.63±4.17)(P<0.05).No obvious complications occurred during or after the operation as limb numbness,atonia,hematomyelia and cerebrospinal fluid leakage.Conclusion TESSYS technique is effective for lumbar pain induced by adjacent segment degeneration after lumbar interbody fusion.
引文
[1]吴江颖,吴凡.躯体性疼痛症状对初诊抑郁症患者生活质量评分影响[J].中国健康心理学杂志,2013,21(7):964-966.
[2]杨朝晖.单侧椎弓根钉内固定并植骨融合术治疗多阶段腰椎间盘突出症[J].医药论坛杂志,2011,32(24):106-107.
[3]刘道德,付志彬,周凌,等.退变性腰椎管狭窄症椎管减压后融合固定手术疗效分析[J].中华实用诊断与治疗杂志,2013,27(9):923-925.
[4]周华,孙宇,王少波,等.椎管扩大成形术后颈椎后纵韧带骨化进展的再手术治疗[J].北京大学学报(医学版),2016,48(2):210-214.
[5]BAE J S,LEE S H,KIM J S,et al.Adjacent segment degeneration after lumbar interbody fusion with percutaneous pedicle screw fixation for adult low-grade isthmic spondylolisthesis:minimum 3 years of follow-up[J].Neurosurgery,2010,67(6):1607-1608.
[6]KUNZE B,DRASSECK T,KLUBA T.Posterior and transforaminal lumbar interbody fusion(PLIF/TLIF)for the treatment of localized segment degeneration of lumbar spine[J].Zeitschrift Für Orthopdie Und Unfallchirurgie,2011,149(3):312-316.
[7]邵立尧.微创手术治疗单节段腰椎管狭窄症的疗效评估[J].中国社区医师,2016,32(7):26-27.
[8]陈晓明,马华松,王蒙,等.脊柱植入物内固定治疗腰椎间盘突出症的复发因素[J].中国组织工程研究,2013,16(30):5539-5544.
[9]GU X,HE S S,ZHANG H L.Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy[J].Clin Anat,2013,26(6):728-734.
[10]CHEN C,CAO X,LIN Z,et al.Minimally invasive unilateral versus bilateral technique in performing single-segment pedicle screw fixation and lumbar interbody fusion[J].J Orthopaedic Surg Res,2015,10:12.
[11]段亮,刘军,弓立群,等.13例肿瘤性骨软化症诊治分析[J].中华实用诊断与治疗杂志,2017,31(7):684-686.
[12]崔力扬,罗建平,田书建,等.颈椎后纵韧带骨化症手术疗效分析[J].中华实用诊断与治疗杂志,2012,26(5):510-511.
[13]王晓平,马华松,陈志明,等.单节段减压融合内固定修复多节段腰椎间盘突出症合并腰椎滑脱:改善支撑力及应力的动态平衡[J].中国组织工程研究,2014,18(53):8641-8645.
[14]SAWADA Y,SUGIMOTO A,HANANOUCHI T,et al.Evaluation of the efficacy of Ajuga decumbens extract supplement in individuals with knee discomfort associated with physical activity:a randomized,double-blind,placebocontrolled study[J].Exp Ther Med,2017,14(5):4561-4571.
[15]罗浩,王健,梁卫东,等.椎间盘置换与前路减压植骨融合修复单节段颈椎病:中期效果评价[J].中国组织工程研究,2014,18(48):7719-7725.
[16]QUANTE M,KESTEN H,RICHTER A,et al.Transforaminal lumbar interbody fusion for the treatment of degenerative spondylolisthesis[J].Orthopade,2012,41(2):153-162.
[17]CHEN H C,LEE C H,WEI L,et al.Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation[J].Neurol Res Int,2015:791943.
[18]李韶辉,余革,陈国勤,等.不同浓度臭氧硬膜外注射对实验兔脊髓的CT和病理学影响[J].中华生物医学工程杂志,2014,20(3):209-211.
[19]KNIGHT M T,JAGO I,NORRIS C,et al.Transforaminal endoscopic lumbar decompression&foraminoplasty:a 10-year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery[J].Int J Spine Surg,2014,8:21.
[20]NICOLA H,SILVA M D,ARANGUREN I J.Relationship between surgical technique and the incidence of adjacent level pathology in lumbar spine fusion:open traditional approach(OTA)versus minimally invasive transforaminal interbody fusion and percutaneous screws(MIS TLIF/PPS)[J].Spine J,2013,13(9):S124-S125.
[21]PAN Z,HA Y,YI S,et al.Efficacy of transforaminal endoscopic spine system(TESSYS)technique in treating lumbar disc herniation[J].Med Sci Monit,2013,22(2):530-539.
[2]杨朝晖.单侧椎弓根钉内固定并植骨融合术治疗多阶段腰椎间盘突出症[J].医药论坛杂志,2011,32(24):106-107.
[3]刘道德,付志彬,周凌,等.退变性腰椎管狭窄症椎管减压后融合固定手术疗效分析[J].中华实用诊断与治疗杂志,2013,27(9):923-925.
[4]周华,孙宇,王少波,等.椎管扩大成形术后颈椎后纵韧带骨化进展的再手术治疗[J].北京大学学报(医学版),2016,48(2):210-214.
[5]BAE J S,LEE S H,KIM J S,et al.Adjacent segment degeneration after lumbar interbody fusion with percutaneous pedicle screw fixation for adult low-grade isthmic spondylolisthesis:minimum 3 years of follow-up[J].Neurosurgery,2010,67(6):1607-1608.
[6]KUNZE B,DRASSECK T,KLUBA T.Posterior and transforaminal lumbar interbody fusion(PLIF/TLIF)for the treatment of localized segment degeneration of lumbar spine[J].Zeitschrift Für Orthopdie Und Unfallchirurgie,2011,149(3):312-316.
[7]邵立尧.微创手术治疗单节段腰椎管狭窄症的疗效评估[J].中国社区医师,2016,32(7):26-27.
[8]陈晓明,马华松,王蒙,等.脊柱植入物内固定治疗腰椎间盘突出症的复发因素[J].中国组织工程研究,2013,16(30):5539-5544.
[9]GU X,HE S S,ZHANG H L.Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy[J].Clin Anat,2013,26(6):728-734.
[10]CHEN C,CAO X,LIN Z,et al.Minimally invasive unilateral versus bilateral technique in performing single-segment pedicle screw fixation and lumbar interbody fusion[J].J Orthopaedic Surg Res,2015,10:12.
[11]段亮,刘军,弓立群,等.13例肿瘤性骨软化症诊治分析[J].中华实用诊断与治疗杂志,2017,31(7):684-686.
[12]崔力扬,罗建平,田书建,等.颈椎后纵韧带骨化症手术疗效分析[J].中华实用诊断与治疗杂志,2012,26(5):510-511.
[13]王晓平,马华松,陈志明,等.单节段减压融合内固定修复多节段腰椎间盘突出症合并腰椎滑脱:改善支撑力及应力的动态平衡[J].中国组织工程研究,2014,18(53):8641-8645.
[14]SAWADA Y,SUGIMOTO A,HANANOUCHI T,et al.Evaluation of the efficacy of Ajuga decumbens extract supplement in individuals with knee discomfort associated with physical activity:a randomized,double-blind,placebocontrolled study[J].Exp Ther Med,2017,14(5):4561-4571.
[15]罗浩,王健,梁卫东,等.椎间盘置换与前路减压植骨融合修复单节段颈椎病:中期效果评价[J].中国组织工程研究,2014,18(48):7719-7725.
[16]QUANTE M,KESTEN H,RICHTER A,et al.Transforaminal lumbar interbody fusion for the treatment of degenerative spondylolisthesis[J].Orthopade,2012,41(2):153-162.
[17]CHEN H C,LEE C H,WEI L,et al.Comparison of percutaneous endoscopic lumbar discectomy and open lumbar surgery for adjacent segment degeneration and recurrent disc herniation[J].Neurol Res Int,2015:791943.
[18]李韶辉,余革,陈国勤,等.不同浓度臭氧硬膜外注射对实验兔脊髓的CT和病理学影响[J].中华生物医学工程杂志,2014,20(3):209-211.
[19]KNIGHT M T,JAGO I,NORRIS C,et al.Transforaminal endoscopic lumbar decompression&foraminoplasty:a 10-year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery[J].Int J Spine Surg,2014,8:21.
[20]NICOLA H,SILVA M D,ARANGUREN I J.Relationship between surgical technique and the incidence of adjacent level pathology in lumbar spine fusion:open traditional approach(OTA)versus minimally invasive transforaminal interbody fusion and percutaneous screws(MIS TLIF/PPS)[J].Spine J,2013,13(9):S124-S125.
[21]PAN Z,HA Y,YI S,et al.Efficacy of transforaminal endoscopic spine system(TESSYS)technique in treating lumbar disc herniation[J].Med Sci Monit,2013,22(2):530-539.